How Supervised Injection Sites Can Save Cities Money

Proponents of safe injection facilities have long cited their success at preventing overdoses and reducing needle-sharing. New research provides another argument for those supporters to draw upon: they're good for everyone's bank accounts.

Supervised injection facilities are centers where people can come to inject heroin, cocaine, and other drugs under the watchful eye of trained staff. The only such facilities that are in legal operation in North America are in Canada, but several United States cities are considering building them. Two recent studies have found that, if they did, San Francisco would reap $3.5 million in health-care savings every year and Baltimore would save $6 million.

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"It's a very cheap facility and the stuff that it's saving is incredibly expensive," says Amos Irwin, lead author on both studies. "A lifetime of HIV treatment. An ambulance call for an overdose to go to the hospital. Emergency room visits."

Irwin's work comes at a time when movements to open supervised injection facilities have sprung up in San Francisco, Baltimore, Seattle, Philadelphia, and Ithaca, New York. These cities and others nationwide continue to struggle with an uptick in deaths from opioid overdoses in recent years.

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"It's huge amounts of money for relatively small numbers because if you have prevented someone from needing a lifetime of HIV care, that's an incredible achievement."

Supervised injection facilities present a possible solution to that epidemic, albeit a hotly debated one. Last month, San Francisco officials announced they were creating a task force to decide whether supervised injection can work in the city. While more than 100 San Franciscans rallied in support, Mayor Ed Lee is reportedly still unconvinced. Seattle has already studied the issue and its mayor endorsed the idea, but the facilities still face tough opposition. Supporters emphasize that supervised injection saves lives, while opponents worry about the moral message it sends.

Irwin works for two non-profit organizations that have called for cities to open supervised injection sites: the Law Enforcement Action Partnership and the Criminal Justice Policy Foundation. For his studies, which were published in the Journal of Drug Issues and Harm Reduction Journal, Irwin worked with scientists from local universities and the Research Triangle Institute, a non-profit research group. The scientists created mathematical models to predict how much it would cost each city to establish and run a smallish supervised injection site, serving 1,700 people a month, as well as how many people such a site would save from health problems stemming from injection drug use.

In Baltimore, a supervised injection facility would prevent about four HIV infections, 21 hepatitis C infections, and about six deaths a year, while getting an additional 121 people into addiction treatment, Irwin and his colleagues found. The facility would cost $1.8 million a year to run, but bring $7.8 million worth of health benefits to the city, the researchers estimated. For San Francisco, the numbers came out to three HIV and 19 hepatitis C infections prevented each year, about one overdose death prevented every four years, and an additional 110 people ushered into treatment. A San Franciscan facility would cost $2.6 million a year to run and bring $6.1 million annually in health benefits.

"It's huge amounts of money for relatively small numbers because if you have prevented someone from needing a lifetime of HIV care, that's an incredible achievement," Irwin says. "It doesn't sound like much, one case, but it's an incredible burden on the community."

It's hard to say exactly whose pocket those savings go into. It should be some combination of individuals, insurance companies and customers, Medicaid, and the city, Irwin says.

Outside researchers consulted by Pacific Standard voiced some concerns about Irwin and his colleagues' analyses. The teams used well-recognized methods for coming up with their numbers, health economists say. They even sometimes used comparatively conservative estimates for the facilities' benefits. Some experts thought Irwin's teams could have done more, however: They could have checked the validity of their theories against real-life cases more often. They could also have included more costs, such as whether the presence of a facility might depress property values for neighbors.

Two of the biggest arguments against supervised injection facilities focus on their effects on property values and whether they sanction drug-taking. The available studies show that the facilities—which have existed for a decade or more in Canada, Australia, and Europe—don't worsen property values or drug use. But the research is debated. Carnegie Mellon University drug-policy expert Jonathan Caulkins, for example, hasn't found any of the studies about drug use convincing. "When the concern is about an impact on an overall level of use in a populace," he says, "it's really difficult to prove the counterfactual."

Whether or not Irwin's numbers are perfectly accurate, they do show there's something to be gained for the community—even those who don't use drugs—from supervised injection facilities. They show the centers aren't expensive to run, relative to the improved health that existing drug users will enjoy. "It contributes to the discussion about 'How does society benefit from investing in these facilities?'" says Bruce Schackman, a health-care policy researcher at Cornell University who didn't work on the analyses. How different American communities will tally up those benefits against their other goals and concerns remains to be seen.